Latest news with #corticosteroids
Medscape
11-07-2025
- Health
- Medscape
Pyoderma Gangrenosum in Pregnancy Often Misdiagnosed
TOPLINE: A systematic review of 63 cases found that pyoderma gangrenosum (PG) during pregnancy or postpartum was often misdiagnosed, delaying treatment and leading to inappropriate interventions. METHODOLOGY: Researchers conducted a systematic review of 62 studies describing 63 patients (average age, 29.9 years) with PG during pregnancy or up to 6 weeks postpartum through September 2023. Of all patients, 27% of patients had a history of PG or PG-like symptoms, 7.9% had a history of inflammatory bowel disease, and 4.8% had another systemic rheumatologic disease. In 71.4% of cases, preceding trauma to the skin was reported. Outcomes included the misdiagnosis rate, treatment, and maternal and fetal complications. TAKEAWAY: During pregnancy, 15.9%, 11.1%, and 7.9% of cases appeared in the first, second, and third trimesters, respectively, while 65.1% were postpartum — primarily at the site of cesarean section scars (55.6%). Of the 47 cases where an initial diagnosis was reported, only 2 cases were recognized as PG; 45 (95.7%) were initially misdiagnosed as bacterial infections, necrotizing fasciitis, or another skin disorder. Among the 26 cases with data on time to diagnosis, the diagnosis was delayed by more than 7 days in 77%. Before the diagnosis of PG, surgical wound intervention and broad-spectrum antibiotics were the most frequent treatments, whereas systemic corticosteroids (88.9%) and cyclosporine (33.3%) were most commonly used after PG was diagnosed. All patients showed improvement after treatment, and treatment-related adverse effects were uncommon. Cesarean section was performed in 40 cases, and 22 of 41 cases with gestational age data were preterm, and there was one case of intrauterine fetal demise. IN PRACTICE: These results highlighted 'the frequent misdiagnosis of PG in this population, leading to treatment delays and inappropriate interventions that worsen the condition,' the authors of the study wrote. The study, 'supported by immunological research,' suggested that pregnancy 'may independently contribute to the development of PG,' they added, noting that further research on safe and effective treatment protocols is needed. SOURCE: This study was led by Gretchen D. Ball, and Sarah Romanelli, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, and was published online on June 30 in the Journal of Drugs in Dermatology. LIMITATIONS: This study was limited by its small sample size and inconsistencies in data reporting across case reports. Collecting comprehensive pregnancy outcomes data was challenging due to limited pregnancy details provided in dermatology journals. DISCLOSURES: This study was supported by the International Dermatology Outcome Measures nonprofit group. One author disclosed receiving grants and honoraria, and holding stocks in various organizations, including Amgen, AnaptysBio, Avotres Therapeutics, Eli Lilly and Company, Novartis, Sanofi, and XBiotech. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
11-07-2025
- Health
- Medscape
Fast Five Quiz: Psoriasis Management
Effective management of psoriasis is paramount in mitigating symptoms and related comorbidities than can impact disease severity and quality of life. Although many treatment options are available, from topicals to systemic biologic and nonbiologic therapies, each therapy comes with its own advantages, disadvantages, and nuances. What do you know about the management of psoriasis? Check your knowledge with this quick quiz. The AAD-NPF recommend limiting the use of ultra-high dose or class 1 corticosteroids to no more than twice daily for up to 4 weeks. While generally safe, high-dose corticosteroids have been associated with adverse events such as skin atrophy, hypopigmentation, adrenal suppression, and Cushing syndrome. However, maintaining use within 4 weeks can minimize these risks. Exceptions to this duration can be made for patients who experience significant flare ups or when treating psoriasis in the palms and soles. Learn more about psoriasis treatments. Patients who are candidates for systemic therapy include those with BSA involvement over 10%, those involving special areas— such as the face, palms, soles, genitalia, nails, or scalp — and failure of topical therapy. This is also consistent with the latest AAD-NPF guidelines, which consider psoriasis to be severe if it impacts the face, hands, feet, scalp, or genitals regardless of BSA involvement and other data indicating that psoriasis lesions on the aforementioned locations is part of the criteria for 'inadequate psoriasis control.' Learn more about psoriasis severity. Biologic therapy can increase the risk of infections, and tuberculosis is especially associated with the use of TNFIs. As such, the AAD-NPF guidelines specifically recommend screening for latent tuberculosis before starting TNF inhibitor therapy in patients with psoriasis. Testing for other viruses, such as HIV, is suggested at the clinician's discretion and depending on patient risk factors. This is consistent with more current international consensuses. Among other biologic treatments, experts report a higher rate of herpes zoster in patients treated with JAK inhibitors rather than TNF inhibitors. After several years of data, biologic therapy does not seem to increase risk for COVID-19 infection; it, along with influenza, is generally not part of general screening in this setting. However, guidelines recommend patients with psoriasis treated with biologic therapy receive annual vaccinations for COVID-19 and influenza to prevent severe infection. Learn more about treatment complications in psoriasis. Joint AAD-NPF guidelines recommend 'proactive treatment' as a strategy for optimal topical psoriasis management to maintain remission, whereby topical treatments are applied twice weekly to previously affected areas. This is similar to a consensus statement from global experts in psoriasis management recommending once or twice weekly application for maintenance therapy after induction. Further, the AAD-NPF also notes that any topical treatment mentioned for use in their guidelines can be used for proactive management, including certain corticosteroids, calcineurin inhibitors, and vitamin D analogues, among several others. Learn more about long-term monitoring in psoriasis. Although biologic therapy can be continued through uncomplicated infections, the AAD-NPF states patients who develop febrile illness, especially when it requires antibiotic treatment, should temporarily discontinue biologics until it resolves. Similarly, biologics can be taken through low-risk surgeries, but the decision to continue biologic therapy through moderate- to high-risk surgery should be made on a case-by-case basis. Similarly, certain systemic nonbiologic therapies have different discontinuation requirements as well. Learn more about infection in psoriasis. Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.
Medscape
17-06-2025
- Health
- Medscape
Hair Experts Report Varying Steroid Techniques for Alopecia
A national survey found broad consensus among hair experts on the use of intralesional corticosteroid (ILC) injections for alopecia but highlighted inconsistencies in dosing and injection parameters. METHODOLOGY: Researchers surveyed 28 dermatologists with hair expertise using a 77-question REDCap survey. Participants averaged 17.7 years of experience, with completion of residency between 1985 and 2022. The response rate was 75% (21 experts completed the survey). The survey assessed ILC injection techniques across alopecia types, including facial alopecia. TAKEAWAY: For nonscarring alopecia, 5 mg/mL was the most common ILC dose (85.7%), followed by 2.5 mg/mL (38.1%); 95.2% of experts injected between 1 and 1.5 mL per session, 95.2% used a 30-gauge needle, and 95.2% injected in a grid pattern. Most experts (71.4%) employed identical ILC techniques for both scarring and nonscarring alopecia, with 61.9% and 60%, respectively, preferring 6-week treatment intervals. The most common ILC dose for scarring alopecia was 5 mg/mL (60%), followed by 7.5 mg/mL (40%) and 10 mg/mL or more (40%). For facial alopecia, 80% of experts used a lower concentration of 2.5 mg/mL, and 90% typically performed 3-4 sessions. For nonscarring alopecia, experts suggested injecting parallel to the direction of hair growth to reduce pain and avoid follicle damage, and for scarring alopecia, they recommended starting with peripheral injections and moving toward the center of the lesion. For facial alopecia, experts recommended shallow injections and avoiding visible vessels to prevent atrophy and bruising. IN PRACTICE: 'Our findings reveal general agreement amongst experts on the use of ILCs for alopecia; however, variation remains in concentration, injection spacing, and treatment duration, especially for facial and scarring alopecia,' the study authors wrote. Although a Delphi study 'could help standardize' ILC treatment approaches, they added, their results 'provide practical guidance for dermatologists on intralesional corticosteroid techniques for the treatment of various alopecia types.' SOURCE: This study was led by Noelle Desir, Department of Dermatology, University of Pennsylvania, Philadelphia, and was published online on June 3 in JAAD International . LIMITATIONS: Limitations included the hair expert identification process and potential response bias in the survey. DISCLOSURES: This study did not receive any funding. One study author reported serving as a consultant, advisory board member, speaker, and investigator for various pharmaceutical and cosmetic companies, including AbbVie, Arcutis Biotherapeutics, Pfizer, and L'Oréal, and also reported receiving royalties from McGraw Hill. Another author reported serving as an advisory board member for Beiersdorf. The remaining authors reported no conflicts of interest.
Medscape
09-06-2025
- Health
- Medscape
Antenatal Corticosteroids Safe for Child Development
A systematic review of 14 studies found that most neurodevelopmental outcomes showed no association with antenatal corticosteroids. While modest decreases were noted in nonverbal intelligence and visual memory scores, studies with a strong design showed no link to adverse development. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 14 studies, comprising eight randomized controlled trial follow-up studies (n = 2233) and six quasi-experimental studies (n = 277,679). Analysis utilized random-effects meta-analyses to synthesize outcomes based on blinded adjudication of appropriateness for pooling by clinical experts in child neurodevelopment. Investigators evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. A total of 23 neurodevelopmental outcomes were examined. TAKEAWAY: Most neurodevelopmental outcomes (19/23) showed no association with antenatal corticosteroid administration. Children exposed to antenatal corticosteroids showed modestly decreased nonverbal intelligence scores (standardized mean difference [SMD], -0.16; 95% CI, -0.32 to -0.01) and visual memory scores (SMD, -0.29; 95% CI, -0.51 to -0.07). Randomized trial follow-ups indicated a nonsignificant trend toward protective effects for general development, while quasi-experimental studies suggested increased risk. Studies with low or moderate risk for bias revealed no association between antenatal corticosteroid administration and adverse child neurodevelopment. IN PRACTICE: 'Among studies with low or moderate risk of bias, we found no association between antenatal corticosteroid administration and adverse child neurodevelopment. There is no consistent evidence that antenatal corticosteroids are associated with an increased risk of impaired childhood neurodevelopment among studies with a strong design to control for confounding,' wrote the authors of the study. SOURCE: The study was led by Jessica Liauw, MD, Department of Obstetrics and Gynaecology at University of British Columbia in Vancouver, Canada. It was published online in Obstetrics & Gynecology . LIMITATIONS: Most randomized controlled trial follow-up studies had significant losses to follow-up, with the two largest studies experiencing 66% and 40% attrition rates, leading to potential selection bias. Researchers noted that few studies specifically investigated the effects of antenatal corticosteroids administered in the late preterm period, limiting understanding of the timing-specific impacts. Additionally, the authors acknowledged that sibling-comparison studies did not adequately control for differences in pregnancy complications that determine why corticosteroids were administered in one pregnancy but not another. DISCLOSURES: The study was supported by a project grant from the Canadian Institutes of Health Research. Liauw received a Michael Smith BC Health Professional Investigator Award, and Jennifer Hutcheon, PhD, was supported by a Canada Research Chair in perinatal population health. The funders had no role in the research design or manuscript submission decisions. The authors reported no potential conflicts of interest.
